Manufacturers Webinar

COVERAG

E GAP D

ISCOU

NT PRO

GRAM

– USER G

ROU

P

Manufacturers Webinar

March 2, 2011

1

COVERAG

E GAP D

ISCOU

NT PRO

GRAM

– USER G

ROU

P

Agenda

• Invoice Correction Process • Payment Confirmation Process• Frequently Asked Questions• Dispute Process • Questions and Answers

2

COVERAG

E GAP D

ISCOU

NT PRO

GRAM

– USER G

ROU

P

Announcements

• Connectivity reminder from TPA• When sending emails to the TPA please

include the P Number in the subject line of the email

3

COVERAG

E GAP D

ISCOU

NT PRO

GRAM

– USER G

ROU

P

Webinar Schedule

• April 6th, 2011 4:00-5:00 p.m. ET• May 4th, 2011 4:00-5:00 p.m. ET• June 1st, 2011 4:00-5:00 p.m. ET• July 6th, 2011 4:00-5:00 p.m. ET

4

COVERAG

E GAP D

ISCOU

NT PRO

GRAM

– USER G

ROU

P

Accomplishments

• Released EFT template o 2/8/2011

• Updated Manufacturer's Report layouto 2/23/2011

• Distributed Test Fileso 2/22/2011

5

COVERAG

E GAP D

ISCOU

NT PRO

GRAM

– USER G

ROU

P

Future TPA Tasks

• Distribute EFT Files• Collect manufacturer payor name as it

will appear on Sponsor’s statements.

6

COVERAG

E GAP D

ISCOU

NT PRO

GRAM

– USER G

ROU

P

Invoice Correction Process (Draft)

• Manufacturers wishing to correct an invoice may do so only if they have been invoiced for NDCs with labeler codes not covered by their CGDP Manufacturer Agreements. CMS publishes the “Participating Manufacturer Labeler Codes” at http://www.cms.gov/PrescriptionDrugCovGenIn/05_Pharma.asp#TopOfPage which documents the current list of labeler codes covered by each Manufacturer. Manufacturers submit their labeler codes at the time they sign the CGDP Manufacturer Agreement and maintain current labeler codes on an ongoing basis as described in “Medicare Coverage Gap Discount Program Guidance” CMS published on December 17, 2011. CMS uses “Participating Manufacturer Labeler Codes” to create the quarterly CGDP Invoice report. The quarterly report invoices Manufacturers for Labeler codes assigned to them as of the first business day following the end of the quarter.

• To request an invoice correction the Manufacturer shall complete the information on the following slide and submit the invoice correction request to the TPA within five (5) days of the date the TPA distributes the CGDP Quarterly Invoice. The TPA will respond within 3 business days. If the TPA confirms the invoice correction, the manufacturer shall not be responsible for paying NDCs with labeler codes invoiced incorrectly. Instead the Manufacturer shall pay all other labeler codes in the invoice. The TPA will follow up with Part D sponsors and other affected Manufacturers to reissue invoices and confirm payment.

7

COVERAG

E GAP D

ISCOU

NT PRO

GRAM

– USER G

ROU

P

Invoice Correction Process (Draft)

• Individual submitting Invoice Correction Request:• Manufacturer (name and P#)• Contact information:

Email addressTelephone numberAddress

• Submission date (date invoice correction form submitted):• Date TPA distributed Quarterly Invoice Report• Report ID

• Labeler Code(s) in question• Total dollars invoiced for Labeler Code(s) in question

8

COVERAG

E GAP D

ISCOU

NT PRO

GRAM

– USER G

ROU

P

Manufacturer Payment Confirmation Report Overview

o Step 1: Manufacturers receive Invoice Report from TPA in their Outbound folder.

– Manufacturers will be invoiced on a quarterly basis. o Step2: According to the terms in the Manufacturers’

Agreement, Part D Manufacturers will have 38 days to pay Sponsors in full.

– The TPA will facilitate the funds transfer between the Manufacturers and Sponsors by providing Sponsor EFT information

o Step 3: Manufacturers are required to send a confirmation of payment to the TPA. There is a five day window after payment is made to the sponsor.

– Invoice report is a versatile format. With minimal change, Manufacturers convert the Invoice Report to the Confirmation of Payment report.

9

COVERAG

E GAP D

ISCOU

NT PRO

GRAM

– USER G

ROU

P

Manufacturer Confirmation Payment Report Creation Steps

Steps to create Confirmation of Payment Report from Invoice Report: 1.Add File date to Manufacturer Header Record (TPAMH):

Field 8- Date Confirmation Report will be returned2.Manufacturers have a Contract Trailer Record for each contract they must pay. On each Contract Trailer (TPACT) populate:

Field 12 - DATE OF PAYMENT Field 13 - PAYMENT AMOUNT

3.On the Manufacturers P Number Trailer (TPAMT) populate: Field 12 - DATE OF PAYMENT Field 13 - PAYMENT AMOUNT

4.At this time the Confirmation Report will need to change from “10MIV” to “10MPC” in field 6 of the TPAMH, field 6 of the TPACH, field 6 of the TPACT and field 6 of the TPAMT records. 5.Rename the file as follows R.#######.RPT.MANUF_CONFIRM

The ####### is a sequential number the Manufacturer received on their Manufacturers Invoice Report.6. Save the file as either a flat file or a text file. You can use a text editor like Wordpad, Notepad or Textpad to create the text file.

7. Send the new file to your Inbound folder.10

COVERAG

E GAP D

ISCOU

NT PRO

GRAM

– USER G

ROU

P

Manufacturer Payment Confirmation File Layout

Legend:

Record Type Code Record Description Notes

TPAMH Manufacturer P Number Header Used to provide TPA overall Payment completion

TPACH Contract Header

LBLR Manufacturer Total at the Labeler Level

TPACT Contract Trailer Used to provide TPA Payment Confirmation to Contract

TPAMT Manufacturer P Number Trailer Used to provide TPA overall Payment completion

Manufacturer Payment Confirmation Report

TPAMH Return for TPA Payment Confirmation

TPACH

LBLR

LBLR

TPACT Return for TPA Payment Confirmation

TPACH

LBLR

TPACT Return for TPA Payment Confirmation

TPAMT Return for Overall Payment Confirmation

COVERAG

E GAP D

ISCOU

NT PRO

GRAM

– USER G

ROU

P

Manufacturer Payment Confirmation: P Number Header and Contract Header

TPAMH

TPACH

Field NO FIELD NAME POSITION PICTURE LENGTH DEFINITION / VALUES

1 RECORD TYPE CODE 1 - 5 X(5) 5 "TPAMH"

2 REPORT ID 6 - 11 9(6) 6Year/Quarter item was placed on the invoice. Format is: "YYYYQQ". QQ represented as "01"-"13".

3 SEQUENCE NO 12 - 18 9(7) 7 An incrementing batch sequence number that starts at 0000001.

4 DDPS SYSTEM DATE 19 - 26 9(8) 8 ‘CCYYMMDD’ = DDPS File creation date.

5 DDPS SYSTEM TIME 27 - 32 9(6) 6 ‘HHMMSS’ = DDPS File creation time.

6 FILE ID 33 - 37 X(5) 5 10MPC - Manufacturer Payment Confirmation

7 MANUFACTURER P NUMBER 38 - 42 X(5) 5 The CMS assigned manufacturer P-Number

8 FILE DATE 43 - 50 9(8) 8

Date the Manufacturer sends the Confirmation of Payment Report to the TPA. (To be filled in when returning file to TPA for payment confirmation. )

9 FILLER 51 - 200 X(150) 150 Spaces

FIELD NO FIELD NAME POSITION PICTURE LENGTH DEFINITION / VALUE

1 RECORD TYPE CODE 1 - 5 X(5) 5 "TPACH"






7 SUBMITTING CONTRACT NUMBER 38 - 42 X(5) 5 The contract that submitted the Gap Discount PDEs

8 FILLER 43 - 200 X(158) 158 Spaces

12

COVERAG

E GAP D

ISCOU

NT PRO

GRAM

– USER G

ROU

P

Manufacturer Payment Confirmation:Contract Trailer

FIELD NO FIELD NAME POSITION PICTURE LENGTH DEFINITION / VALUES

1 RECORD TYPE CODE 1 - 5 X(5) 5 "TPACT"


3 SEQUENCE NO 12 - 18 9(7) 7An incrementing batch sequence number that starts at 0000001.




7 SUBMITTING CONTRACT NUMBER 38 - 42 X(5) 5 The contract that submitted the Gap Discount PDEs

8 DETAIL RECORD COUNT 43 - 49 9(7) 7 The number of Labeler records for this Contract.

9TOTAL REPORTED GAP DISCOUNT PREVIOUS AMOUNT 50 - 63 S9(12)V99 14

Reported Gap Discount that was reported on preceding Data Report

10TOTAL REPORTED GAP DISCOUNT CURRENT AMOUNT 64 - 77 S9(12)V99 14 New Gap Discount amounts invoiced this quarter.

11 TOTAL GAP DISCOUNT AMOUNT THIS PERIOD 78 - 91 S9(12)V99 14Net payment amount this quarter,calculated as the "current amount" minus the "previous amount"

12 DATE OF PAYMENT 92 - 99 9(8) 8Date payment was paid. If payments were made on multiple days, use final payment date

13 PAYMENT AMOUNT 100 - 113 S9(12)V99 14Amount of payment made. If payments were made on multiple days, use the sum of all payments.

14 EFT INDIVIDUAL IDENTIFICATION NUMBER 114 - 128 X(15) 15

A descriptive identifier that should be used by the manufacturer as the Individual Identification Number on the EFT Payment that is made to Contracts. Contracts should be able to identify the payment from the manufacturers on their banking records using this number. Format is:"CG" + Year/Quarter (i.e. "YYQQ") + Manufacturer P Number missing the P (i.e."8888") + Contract Number (i.e. "H1234")Example: "CGYYQQ8888H1234"

15 FILLER 129 - 200 X(72) 72 Spaces

TPACT

13

COVERAG

E GAP D

ISCOU

NT PRO

GRAM

– USER G

ROU

P

Manufacturer Payment Confirmation: P Number Trailer

FIELD NO FIELD NAME POSITION PICTURE LENGTH DEFINITION / VALUES

1 RECORD TYPE CODE 1 - 5 X(5) 5 "TPAMT"






7 MANUFACTURER P NUMBER 38 - 42 X(5) 5 The CMS assigned manufacturer P-Number

8 DETAIL RECORD COUNT 43 - 49 9(7) 7The number of Contracts this Manufacture will pay (i.e. count of TPACT records.)

9 TOTAL REPORTED GAP DISCOUNT PREVIOUS AMOUNT 50 - 63 S9(12)V99 14Reported Gap Discount that was reported on preceding Data Report

10 TOTAL REPORTED GAP DISCOUNT CURRENT AMOUNT 64 - 77 S9(12)V99 14 New Gap Discount amounts invoiced this quarter.

11 TOTAL GAP DISCOUNT AMOUNT THIS PERIOD 78 - 91 S9(12)V99 14Net payment amount this quarter,calculated as the "current amount" minus the "previous amount"

12 DATE OF PAYMENT 92 - 99 9(8) 8

Date of last payment for this invoice. If payments were made on multiple days, use final payment date. (To be filled in when returning file to TPA for payment confirmation.)

13 PAYMENT AMOUNT 100 - 113 S9(12)V99 14Total amount of payments made for this invoice. (To be filled in when returning file to TPA for payment confirmation.)

14 FILLER 114 - 200 X(87) 87 Spaces

TPAMT

14

COVERAG

E GAP D

ISCOU

NT PRO

GRAM

– USER G

ROU

P

Frequently Asked Questions

• Invoice Data

• EFT

• Labeler Code

• Third Party Vendor Roles

15

COVERAG

E GAP D

ISCOU

NT PRO

GRAM

– USER G

ROU

P

Dispute Process – Overview (Draft)

• Dispute Reports: Proposed model is similar to payment confirmation report model (File formats to be developed.)o Manufacturer uses Manufacturer Data report to create the

Dispute Submission fileo TPA uses Dispute Submission Report to create Dispute Reply

Report

16

Dispute Timeline for 1st Quarter CGDP Reports

TPA distributes CGDP quarterly reports April 30, 2011

Manufacturer submits disputes to TPA (report distribution date + 60 days) June 29, 2011

TPA sends dispute reply report (report distribution date + 120 days) August 29, 2011

COVERAG

E GAP D

ISCOU

NT PRO

GRAM

– USER G

ROU

P

Dispute Process Approach (Draft)

• For each CGPD record disputed, Manufacturer submitso Dispute Reason Code; examples

– DUP – duplicate– OTH - other

o Data specific for individual Dispute Reason Codeo Optional text field with additional information to further

explain the dispute o Optional comment record to further explain the dispute(s).

Each comment record has a unique identifier which the manufacturer associates with each dispute described in the comment record.

• TPA replies with dispute reply code(s).

17

COVERAG

E GAP D

ISCOU

NT PRO

GRAM

– USER G

ROU

P

Sample Dispute: Duplicate gap discount record (Draft)

Dispute Submission ReportDispute Reason Code: DUPData to support dispute: Detail Reference NumberText field: optionalComment record - optional

unique identifier (required if comment record is submitted.)

Dispute Reply ReportDispute reply code:

18

Documents

Manufacturers Webinar